Pneumococcal infection causes an estimated 40,000 deaths annually in the United States, accounting for more deaths than any other vaccine-preventable bacterial disease. Approximately half of these deaths potentially could be prevented through use of vaccine. Vaccination against this disease is encouraged for all people 65 years of age or older and for younger individuals with certain chronic diseases or immunosuppression. Advocacy for immunization is consistent with the precepts of pharmaceutical care, and pharmacists can promote pneumococcal immunization by assuming the roles of educator, facilitator, and immunizer. The long-term objective of the proposed study is to increase pneumococcal vaccination rates among high- risk adults by utilizing community pharmacists to (1) advise patients about pneumococcal disease and (2) administer the vaccine. More specifically, the study will evaluate the effectiveness of an integrative pro-active pneumococcal immunization program delivered by community pharmacists. The study will target community- dwelling adults (age 18-64) at high-risk for complications from pneumococcal infection through community pharmacies. Participants will be recruited using prescription profile records maintained by the pharmacies where they obtain their medications. A selected sample of identified individuals will receive informational materials focused on the prevention of pneumococcal disease. The prescription profiles of the individuals identified will be flagged to prompt the pharmacist to offer the patient the opportunity to receive a pneumococcal vaccine. The flags will remain in place from January 1, 2006 until October 1, 2006. Patients identified as candidates for the pneumococcal vaccine through this process will be given the opportunity to receive a pneumococcal vaccine, and their primary care physician will be notified. Effects of the intervention on the proportion of individuals who receive a pneumococcal vaccination will be evaluated based on differences in vaccination rates before and after the study. A comparison of vaccination rates between the primary study sample and a comparison sample not exposed to the intervention will also be evaluated. [unreadable] [unreadable] [unreadable]